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Eczema and contact dermatitis

Eczema is an extremely common skin condition that causes itchy, dry, red and cracked skin. It can occur in infancy and childhood, but sometimes develops later on in life or continues throughout life. In most cases the cause cannot be found, and it is termed endogenous (or internal) eczema. Sometimes allergies or irritants may be involved, when it is termed exogenous (external) eczema. Symptoms can come and go and, although it can be severe, most people suffer only mildly with it.

There are several forms of eczema, including atopic, seborrhoeic varicose as well as allergic contact eczema. The principle feature of eczema is the itching. In severe cases this can become almost unbearable leading to sleep loss, frustration, stress and depression. It can affect the whole family, not just the person with eczema, so treatment and management of the condition is important and leads to a real improvement in quality of life.

Early and proper treatment can prevent the disease from becoming chronic (long term) and reduces the damage to the skin from long term scratching.

Eczema explained

The condition can be acute or chronic or both:

Acute eczema manifests in a rapidly evolving red (inflamed) itchy rash, which may be blistered and swollen.

Chronic eczema refers to a longstanding irritable area. It is often darker than the surrounding skin and thickened (lichenified), and much scratched.

An in-between state is known as subacute eczema.

About one in five people in the population suffer from eczema at some time in their lives. It has a variety of different causes and various patterns. Psychological stresses can aggravate eczema, we think by interacting with the normal immune system.

Due to the inflammation and swelling within the epidermis (outer layer of the skin) the normal skin barriers breakdown. This means that water is lost through the skin more readily and bacteria or irritants are able to pass through more easily. A person with eczema will find that their skin dries out more with soaps and detergents and it will quickly become irritated, cracked and sore. As a consequence, it is more susceptible to infections.

Atopic eczema is the most common type and often runs in families. It is also linked to hay fever and asthma.

Eczema in children

Five to 15 per cent of children up to the age of seven are affected by atopic eczema. The majority grow out of it after this age, although they are likely to have sensitive or irritable skin for the rest of their lives. The cause of atopic eczema is not properly understood but it is thought to be a combination of genetic and environmental factors.

This condition is not usually constant and typically there are flare ups, although the skin tends to be dry and itchy most of the time. Typically the pattern of atopic eczema evolves with age.

Babies

Under one year old, babies often have widely distributed eczema. The skin can be dry, scaly and red with small scratch marks made by sharp little nails. The cheeks of infants are often the first place to be affected.

Toddlers

As toddlers begin to move around the eczema becomes more localised and thickened. They scratch vigorously and the eczema may look very raw and uncomfortable. Eczema in this age group often affects the extensor (outer) aspects of joints, particularly the wrists, elbows, ankles and knees, and also the genitals. As the child grows older the pattern frequently changes to the flexor surfaces of the same joints (the creases) with fewer outer signs (although these can persist into later childhood). Due to constant scratching and rubbing the affected skin often becomes lichenified.

Older children

The pattern of eczema in older children tends to be flexural, affecting the elbow and knee creases. Other susceptible areas include the eyelids, earlobes, neck and scalp. Severe itchy blisters can recur on the palms, fingers and sometimes on the feet. This is known as pompholyx or vesicular hand/foot dermatitis. Many children develop a nummular pattern of atopic eczema. This refers to small coin-like areas of eczema around the body which are dry, red and itchy. They can be mistaken for ringworm (a fungal infection). Mostly the eczema improves during school years and it may completely clear up by the teens. However the barrier function of the skin is never entirely normal.

Adults

Atopic eczema in adults can present in different ways. The pattern may be diffuse but the skin is often more dry and lichenified than in children. Commonly there are persistent localised patches of eczema, possibly confined to the hands, eyelids, flexures and nipples, or all these areas. Recurrent staphylococcal infections may be prominent. Atopic eczema is a major contributing factor to occupational irritant contact dermatitis. This commonly affects hands that are frequently exposed to water, detergents and/or solvents. Hand dermatitis tends to be dry and thickened, but may also be blistered.

Typical triggers for flares of atopic eczema are:

Soap and detergents

Skin Infection

House-dust mites and their droppings

Animal dander (fur, hair) and saliva

Pollens

Overheating

Rough clothing

Foods allergies

Treatments

If you have any form of eczema we recommend a consultation with a qualified Dermatologist to diagnose and investigate the cause of your problem and discuss a treatment plan. Our Dermatologists will take a detailed history and examine the whole skin. We are often able to identify the cause without any investigations.

If we suspect an allergic cause we may carry out skin patch testing with the suspected allergens, which cause allergic problems. These are often helpful in diagnosing allergic skin diseases.

Patch testing is simple and carries a low risk to perform

The basics of eczema treatment are the avoidance of irritants such as harsh soaps and detergents and the regular and continued use of emollients, both in the bath but also directly on to the skin. This will improve the hydration of the skin and repair the epidermal barrier function of the skin, reducing the future impact of drying from the environment, irritants and allergens.

Topical corticosteroids or the newer immunomodulator drugs, such as tacrolimus or pimecrolimus, are used to settle the redness and inflammation within the skin. These reduce swelling, lichenification (thickening) of the skin and repair the damage to the barrier function of the skin, which reduces water loss. Most people can expect their symptoms to at least improve and in many cases the condition will clear up completely.